Page 137 - Cover Letter & Evaluation for Carol Evans

6/6/2018 Your Plan Results
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $20.40 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $244.80 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $1 - $4, 25% - 35%
MTM Program : Yes

Express Scripts Medicare - Saver (PDP) (S5660-244-0)
Organization: Express Scripts Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $22.60 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $271.20 $405 :N/A
4 out of 5 stars
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A
Annual: N/A $1 - $4, 18% - 44%
MTM Program : Yes

AARP MedicareRx Walgreens (PDP) (S5921-409-0)
Organization: UnitedHealthcare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $26.80 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $321.60 $405 :N/A
3.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $0 - $31, 25% - 32%
MTM Program : Yes

WellCare Classic (PDP) (S4802-092-0)
Organization: WellCare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $26.90 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $322.80 $405 :N/A
2.5 out of 5
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A stars
Annual: N/A $0 - $37, 25% - 42%
MTM Program : Yes

SilverScript Choice (PDP) (S5601-056-0)
Organization: SilverScript
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:
Retail $28.50 Annual Drug Deductible: All Your Drugs on Formulary Enroll
Annual: $342.00 $100 :N/A
4 out of 5 stars
Mail Order Drug Copay/ Coinsurance: Drug Restrictions: N/A
Annual: N/A $3 - $41, 31% - 45%
MTM Program : Yes

Express Scripts Medicare - Value (PDP) (S5660-130-0)
Organization: Express Scripts Medicare
Estimated Annual Monthly Deductibles: [?] and Drug Coverage [?] , Drug Overall Star
Drug Costs: [?] Premium: Drug Copay [?] / Restrictions [?] and Rating: [?]
[?] Coinsurance: [?] Other Programs:

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